http://ajs.tums.ac.ir/index.php/ajs/issue/feed Academic Journal of Surgery 2018-02-21T10:37:25+0330 AJS ajs@tums.ac.ir Open Journal Systems http://ajs.tums.ac.ir/index.php/ajs/article/view/126 Educating Medical Students: Strategies and New Methods 2018-02-17T15:37:38+0330 Ali Ghorbani-Abdehgah dr.eslamian@gmail.com Mehdi Jafari dr.eslamian@gmail.com Alireza Eslamian dr.eslamian@gmail.com <p>In educating medical students, it is paramount that the educators succeed in imparting knowledge, attitude, and skills required for the practice of medicine. Due to the importance of this task, there is constant innovation in the field of medical education. Successful acquisition of required skills is dependent upon the appropriate learning environment as well as the presence of motivated and knowledgeable teachers (1, 2).</p><p>Teaching and learning methods are an important topic in medical education. Currently, the chief method of education in medical settings is lecturing. This method, which is prevalent across many levels of the education system, is appropriate for imparting much information from educator to student. However, lecturing does not lead to semantic deep learning and is inadequate for teaching medical students (3). To improve students’ capabilities, it is important to use newer methods; so that the leaners acquire the appropriate essential skills and receive feedback on their performance before encountering any patients; so that they are less likely to harm patients. After reviewing their syllabi, many medical universities, including the Tehran University of Medical Sciences, Iran, have opted to adopt student-oriented teaching methods. One such method is Team-Based Learning (TBL) (2).</p><p>Team-based learning leads to deeper learning, easier acquisition of content by students, and more student engagement in classes. Due to short lengths of patients stay, sub-specialization of hospitals beds, and increasing societal attention to patient care, hospitalized patients in most circumstances do not provide required opportunities for teaching clinical skills. Furthermore, due to the importance of learning on patient health as well as higher attention on patient rights, current focus is on teaching clinical and communication skills through virtual spaces. Medical education has undergone significant changes in past two decades, leaning towards Clinical Skills Centers for teaching clinical, diagnostic, and communication skills (4).</p><p>In these centers, various teaching methods such as lecturing, small group discussions, virtual reality technologies, using scientific instruments, role playing, role modeling, simulated patients, manikins, and multimedia moulages are used to teach scientific, communicative, and mental skills (1). On the other hand, clinical education is an important pillar of any medical course; crucial because education is presented in a professional real-life setting and the learners will be more enthusiastic as a result of their active participation. Professors will be models of appropriate thinking, behavior, and professional attitude. This is the environment in which skills such as history taking, physical examinations, clinical reasoning, decision making, empathy, and professional responsibility are learned in a unified and integrated manner (5).</p><p>In conclusion, a successful educational organization must have a flexible, but organized, program in line with the university’s educational goals. Having the appropriate organization and planning is crucial in training physicians that can diagnose and treat disease as well as work towards preventing it in the society.</p> 2017-12-29T19:39:52+0330 ##submission.copyrightStatement## http://ajs.tums.ac.ir/index.php/ajs/article/view/127 Effects of Intraluminal Vancomycin in Decreasing Central Venous Catheter Infection 2018-02-17T15:37:38+0330 Behnam Molavi bn.molavi@yahoo.com Ali Ghorbani-Abdehgah bn.molavi@yahoo.com Ali Yaghoobi-Notash bn.molavi@yahoo.com Aidin Yaghoobi-Notash bn.molavi@yahoo.com Reza Eslamain bn.molavi@yahoo.com Ahmadreza Soroush bn.molavi@yahoo.com <p><strong>Background:</strong> Central venous catheters (CVC) are important intravenous routes, that nowadays they can be used for various reasons including resuscitation management, intravenous feeding, chemotherapy drugs, and blood transfusions. Due to the special importance and increasing usage of these catheters lengthening the duration of these catheters are very important. Infections are the most common cause of removal of this catheter.</p><p><strong>Methods:</strong> In this prospective study (cohort), 80 patients with central venous catheter were divided into two groups. In the first group Vancomycin once per day injected inside catheter equal to their intraluminal volume and remained for 2 h, then catheter was aspirated and washed. But in control group catheter was washed only with normal saline. Finally, catheter infection rates in the two groups were compared.</p><p><strong>Results:</strong> In the group that used intraluminal Vancomycin, catheter infection was ‎observed in 3 cases and was confirmed by blood culture, but in none of them ‎catheter infection agent was not Gram-positive cocci.‎ In control group, 18 cases of catheter infection were confirmed by culture that in 16 cases were caused by Gram-positive cocci that in 14 cases catheter was removed, and in 2 cases of catheter infection, infectious agent was Staphylococcus epidermidis which catheter maintained with appropriate antibiotics.</p><strong>Conclusions:</strong> Use of the intraluminal Vancomycin significantly reduces the rate of infection and thus increase the survival rate of CVC. 2017-12-29T19:39:53+0330 ##submission.copyrightStatement## http://ajs.tums.ac.ir/index.php/ajs/article/view/113 Comparative Study of Laparoscopic Cholecystectomy Versus Open Cholecystectomy in Elderly Patients: An Observational Comparative Study 2018-02-17T15:37:38+0330 Shobhit Gupta Shobhi.shobhit@gmail.com Naveen Kumar drnaveenvmmc@gmail.com <p><strong>Background: </strong>Surgery for cholelithiasis is more common in elderly patients as the incidence of gallstones increases with age. Age is one of the critical factors affecting the mortality and morbidity rates after open cholecystectomy (OC). The aim of this report was to evaluate and comparing the outcome of laparoscopic cholecystectomy (LC) in elderly patients (≥ 65 years old) with that of OC.</p><p><strong>Methods:</strong> A prospective observational comparative study was conducted in the Department of General Surgery at R.G. Kar Medical College and Hospital, India, from January 2012 to June 2013. 50 patients were involved. Group 1 had patients planned for conventional LC, i.e., LC group and Group 2 with OC, i.e., OC group. Patients included were the cases who aged 65 years and above, with symptomatic gallstone disease, with asymptomatic gallstone with associated illnesses or with anticipated complications. Various variables were compared intraoperatively and postoperatively.</p><p><strong>Results: </strong>Significant differences were seen in LC group with more duration of surgery than OC group. The pain score was significantly low in LC group after 6 and 24 hours. The duration of hospital stay was also significantly less in LC group. Pulmonary function tests were done on 1<sup>st</sup> and 6<sup>th</sup> post-operative days showed a significant difference of peak expiratory flow rate, forced expiratory volume<sub>1</sub>, and forced vital capacity between LC and OC on 1<sup>st</sup> post-operative day.</p><strong>Conclusions:</strong> LC should be advised for elderly patients as an elective procedure safely as post-operative morbidity is much less in LC compared to the OC. 2017-12-29T19:39:52+0330 ##submission.copyrightStatement## http://ajs.tums.ac.ir/index.php/ajs/article/view/116 Plethysmography Variability Index as a Guidance for Intraoperative Fluid Management in Cesarean Section Delivery under Spinal Anesthesia: A Pilot Study 2018-02-17T15:37:38+0330 Reza Atef-Yekta r.atefyekta@gmail.com Omid Azimaraghi o.azimaraghi@gmail.com Ali Movafegh dralimovafegh@gmail.com Seyed Mojtaba Marashi mmarashi@tums.ac.ir Siamak Tavakoli s.tavakolia@gmail.com Alireza Saliminia alirezasaliminia@yahoo.com <p><strong>Background:</strong> Plethysmography variability index (PVI) is a measure of the dynamic changes in the perfusion index (PI) that occur during one or more complete respiratory cycles. This study was designed to investigate the accuracy of PVI in guidance of fluid management in parturient undergoing cesarean section surgery under spinal anesthesia.</p><p><strong>Methods:</strong> This randomized clinical trial was performed on 21 consecutive patients who were candidate for cesarean section surgery under spinal anesthesia at Shariati Hospital in Tehran, Iran, between April 2015 and April 2016. The patients were randomly assigned to one of the PVI or conventional group. In all patients, serum level of lactate, mean arterial pressure (MAP), total amount of infused intraoperative fluids, urine output, and duration of surgery were recorded.</p><p><strong>Results:</strong> In total, 21 patients (10 in PVI group and 11 in control group) were assessed. The trend of the change in MAP was significantly different between the two groups with a downward trend in PVI group and a fluctuated trend in the conventional group (P = 0.003). The mean amount of infused fluid was 2565.00 ± 563.74 ml in PVI group that was significantly lower than control group (3122.73 ± 321.99 ml) (P = 0.011). Although urine output was numerically higher in PVI than in control group (425.00 ± 274.12 ml vs. 322.00 ± 121.82 ml), it was not statistically significant (P = 0.292). In PVI group, the primary value of PVI was 23.80 ± 6.93 that reached to 12.20 ± 1.75 at the end of surgery indicating a significant reduction (P &lt; 0.001).</p><strong>Conclusions:</strong> Regarding clinical and hemodynamic stability as well as fluid therapy responsiveness (less requiring fluids within surgery), PVI monitoring seems to be superior to the conventional method. 2017-12-29T19:39:53+0330 ##submission.copyrightStatement## http://ajs.tums.ac.ir/index.php/ajs/article/view/125 Evaluation of Early Removal of Urinary Catheter after Rectal Cancer Surgery 2018-02-17T15:37:38+0330 Behzad Nemati-Honar behzadnematihonar@yahoo.com Seyed Mohammad Ali Hosseini-Lavasani malavassani@gmail.com Majid Samsami samsamimd@gmail.com Bita Eslami dr.bes.96@gmail.com Amirmohsen Jalaeefar jalaeefar@gmail.com <p><strong>Background: </strong>It is a common practice to catheterize the bladder during major surgical procedure and leave the catheter <em>in situ</em> to avoid post-operative urinary complications such as retention or incontinence. Catheter removal on post-operative day 5 is a routine, and it causes some urinary problems and longer hospital stay. The objective of this study was to evaluate the effect of early removal of urinary catheter on the 1<sup>st</sup> day after rectal cancer surgery, on the rate of urinary complications.</p><p><strong>Methods:</strong> This quasi-experimental study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences, Iran. 80 patients with rectal cancer underwent surgery at Imam Hossein Hospital from 2015 to 2016, were recruited with planned early removal of urinary catheter after surgery. Personal and disease information was recorded in all patients after obtaining the informed consent. Urinary complications were checked by the surgical resident after the operation.</p><p><strong>Results: </strong>Mean age of participants was 56.64 ± 14.90 (range: 22-84 years). From these patients 46 (57.5%) were male, and 34 (42.5%) were female. Two cases (2.5%) were manifested urinary problems in men. One of them reported urinary retention and the other one had hematuria. Both patients were in Stage III of rectal cancer and had laparoscopic surgery. Urinary incontinence was not reported in any patients.</p><strong>Conclusions:</strong> In patients who undergoing rectal cancer surgery, urinary catheter can be removed on the 1<sup>st</sup> post-operative day without any significant increase in urinary complications. 2017-12-29T19:39:53+0330 ##submission.copyrightStatement## http://ajs.tums.ac.ir/index.php/ajs/article/view/128 Pancreas Transplantation: A Review of Literature 2018-02-17T15:37:38+0330 Maria Ajdari srsaidi@tums.ac.ir Reza Saidi srsaidi@tums.ac.ir Mehdi Jafari srsaidi@tums.ac.ir Abolfazl Shojaiefard srsaidi@tums.ac.ir Shirzad Nasiri srsaidi@tums.ac.ir Ali Mir srsaidi@tums.ac.ir Ahmadreza Soroush srsaidi@tums.ac.ir <p>Pancreas transplantation has emerged as an effective treatment for patients with diabetes mellitus, especially those with established end-stage renal disease. Surgical and immunosuppressive advances have significantly improved allograft survival. The procedure reduces mortality compared with diabetic kidney transplant recipients and waitlisted patients. Improvements in diabetic nephropathy and retinopathy have also been demonstrated. Pancreas transplantation can improve cardiovascular risk profiles, improve cardiac function, and decrease cardiovascular events. Finally, improvements in diabetic neuropathy and quality of life can result from pancreas transplantation. Pancreas transplantation remains the most effective method to establish durable euglycemia for patients with diabetes mellitus.</p> 2017-12-29T19:39:53+0330 ##submission.copyrightStatement## http://ajs.tums.ac.ir/index.php/ajs/article/view/103 Inguinal Canal Hydatidosis Presenting as Irreducible Inguinal Hernia: A Case Report 2018-02-21T10:36:57+0330 Nasser Malekpour-Alamdari Nassermalekpour@gmail.com Barmak Gholizadeh barmak.gholizadeh@gmail.com Fereshteh Kimia ferkimia@gmail.com <p><strong>Background: </strong>Hydatidosis is a parasitic infestation caused by <em>Echinococcus granulosus</em>. This tapeworm commonly affects liver and lungs. Its diagnosis in unusual locations may be make some challenges for practicing physicians.</p><p><strong>Case Report: </strong>A 45-year-old man presented with bulging and discomfort in the right lower quadrant from 2 years ago. Computed tomographic examination showed an oval cyst measuring about 7 cm × 15 cm in the inguinal area. In the operating room, after sealing the area with appropriate amounts of gauze soaked in silver nitrate the cyst punctured and clear fluid aspirated from the cyst; then, the cyst was sterilized using silver nitrate and opened. Daughter cysts were extracted from the cyst, the cyst was carefully freed from surrounding structures, and total excision of the cyst was performed. Post-operative period was uneventful, and no recurrence was encountered during the 6-month follow-up period.</p><strong>Conclusions: </strong>In this case, we present a patient with swelling in the inguinal area, which turns out to be hydatid cyst. To our knowledge, there has been no case of hydatid cyst arising primarily from inguinal canal. Hydatid disease can present with many different symptoms, and in this case, we present one the rare presentations of this disease. So that for a surgeon who works in the endemic areas, it is important to be aware about the varying presentations of the disease so that in the operation room should do required preparations to prevent unwanted serious problems such as spillage of intracystic materials. 2017-12-29T19:39:53+0330 ##submission.copyrightStatement## http://ajs.tums.ac.ir/index.php/ajs/article/view/54 Right-sided Diaphragmatic Eventration: A Case Report 2018-02-21T10:37:25+0330 Keivan Sabooni keivansab@yahoo.com Reza Karami reza_karami1367@yahoo.com <p><strong>Background: </strong>Diaphragmatic eventration is a rare congenital developmental defect of the muscular portion of diaphragm resulting diaphragmatic elevation. Eventration can be unilateral or bilateral, partial or complete. It is more common in males, and involves more often the left hemidiaphragm.</p><p><strong>Case Report:</strong> A 62-year-old man presented with complaints of chronic abdominal pain and dyspnea. In recent months, he suffered from an exertional dyspnea. With the radiological investigations, a diagnosis of eventration of right diaphragm was made and the diaphragmatic plication was done.<strong></strong></p><p><strong>Conclusions:</strong> Complete eventration of diaphragm invariably occurs on the left side; but partial eventration of diaphragm occurs virtually on the right side, and is diagnosed based on different radiologic findings. In this case, complete eventration of diaphragm was seen on the right side which is a rarity.</p> 2018-02-17T15:29:10+0330 ##submission.copyrightStatement##